The Role of Felt or Enacted Criticism in Parents' Decision Making in Differing Contexts and Communities: Toward a Formal Grounded Theory.

Felt or enacted criticism was identified as a significant influence on White British parents' decision making during acute childhood illness in a substantive grounded theory "Containing acute childhood illness within family life." These parents sought to avoid further criticism, sometimes leading to delayed consultation. Using Glaserian grounded theory principles, we conducted a secondary analysis of data from three studies, to establish the transferability and modifiability of the original theory to other settings and communities in Ireland and England. Felt or enacted criticism was found to operate across the childhood age range, social groups, and settings. Parent's strategies to avoid criticism reduced contacts with health professionals, access to support and, more worryingly, communication about their child's health. These findings demonstrate the wider applicability, or "work" in Glaser's terms, of the concept in the English speaking Western world. Findings indicate the need for nurses to identify and mitigate sources of criticism.

Parents' help-seeking behaviours during acute childhood illness at home: A contribution to explanatory theory.

Uncertainty and anxiety surround parents' decisions to seek medical help for an acutely ill child. Consultation rates for children are rising, yet little is known about factors that influence parents' help-seeking behaviours. We used focus groups and interviews to examine how 27 parents of children under five years, from a range of socioeconomic groups in the East Midlands of England, use information to make decisions during acute childhood illness at home. This article reports findings elucidating factors that influence help-seeking behaviours. Parents reported that decision-making during acute childhood illness was influenced by a range of personal, social and health service factors. Principal among these was parents' concern to do the right thing for their child. Their ability to assess the severity of the illness was influenced by knowledge and experience of childhood illness. When parents were unable to access their general practitioner (GP), feared criticism from or had lost trust in their GP, some parents reported using services elsewhere such as Accident and Emergency. These findings contribute to explanatory theory concerning parents' help-seeking behaviours. Professional and political solutions have not reduced demand; therefore, collaborative approaches involving the public and professionals are now needed to improve parents' access to information.

Parent's information seeking in acute childhood illness: what helps and what hinders decision making?

CONTEXT: Acute illness is a universal experience in early childhood. Parents find it difficult to determine whether or not their child requires medical care and seek information to inform their decision making. Little is known about parents' information seeking behaviour and what helps or hinders their decision making. OBJECTIVE: This study aimed to explore parents' use of information resources during decision making in acute childhood illness at home. DESIGN/METHOD: This exploratory qualitative study used focus groups and interviews to collect data from parents of children under 5 years of age. SETTING AND PARTICIPANTS: Twenty-seven parents were recruited in the East Midlands, UK, in South Asian and Gypsy/Travelling communities, a Children's Centre and a private sector day nursery. FINDINGS: Parents' pre-consultation information seeking was dominated by the internet, albeit with limited success. Parents liked easy to access, professionally validated and simple messages with access to more detailed information. Some parents always sought information through personal contact, whilst others did so when independent information seeking failed. When consulting a healthcare professional, parents liked to be given information to refer to later, although the information received varied. Importantly, neither hard copy nor the internet was accessible for parents with low levels of literacy. DISCUSSION AND CONCLUSIONS: Although there is a wealth of information parents can access independently, our findings indicate a need for easy access to clearly signposted, professionally validated resources and available in a range of formats provided through different delivery systems. One size does not fit all.

The role of felt or enacted criticism in understanding parent's help seeking in acute childhood illness at home: a grounded theory study.

BACKGROUND: Parents with young children often worry about whether or not to seek medical help for a sick child. Previous research identified parents' anxieties surrounding help seeking from health services but did not explore or explain the underlying psychosocial processes taking place in families at these times. OBJECTIVES: This paper presents findings from a British grounded theory study on family management of acute childhood illness at home, which provide an explanation for parent's helping seeking behaviours. DESIGN: Glaserian grounded theory methodology was used for the study. SETTING: The sampling sites for the study were in two towns in the East Midlands with population profiles close to the national average for the UK. PARTICIPANTS: Initial purposeful and later theoretical sampling resulted in a sample of fifteen families with children aged between 1 month and 8 years of age. METHODS: Four sets of data collection took place between 2001 and 2007. Unstructured family interviews were conducted with adult family members and a draw, write or tell technique was used to interview any children over 4 years of age. Theoretical sensitivity and constant comparative analysis were employed to achieve theoretical saturation around a core category. FINDINGS: Felt or enacted criticism teaches parents informal social rules which direct how they are expected to behave. Their desire to avoid such criticism of their moral status as 'good' parents creates significant hidden anxiety about when to seek medical help. This anxiety sometimes leads to late consultation with potentially serious consequences for their child's health. CONCLUSION: The grounded theory indicates the need for significant investment in the training of nurses and other health professionals to reduce parents' (and other patients') experiences of felt or enacted criticism and the consequent hidden anxiety. When parents are worried about their child's health, they need to be able to seek help from health professionals without fear of criticism. These conclusions are primarily limited to universal health care environments.

Containing acute childhood illness within family life: a substantive grounded theory.

Acute childhood illness is a universal experience for children and families. This paper presents the central process of a Glaserian grounded theory study which explored family management of acute childhood illness at home. Twenty-nine interviews were conducted with 15 families of children 0-9 years of age. Constant comparative analysis generated the substantive grounded theory 'Containing acute childhood illness within family life'. This informal social rule was identified from families' persistent desire to do the right thing, for their child and in the eyes of others in social life. Families perceived that they were expected to contain illnesses which are defined as minor and to seek medical help for 'real' illnesses. Considerable uncertainty was evident around defining the illness and the legitimacy of seeking medical help. Their concern with the latter indicates doctors' role as moral agents for parents' behaviour, directing the containment of acute childhood illness.

Research with children: a critical review of the guidelines.

The development of research with children highlights a number of ethical issues for the research process concerning consent, confidentiality and protection from harm. This article aims to analyse the extent to which these issues have been considered within the published guidance for research involving children. Several key principles emerged: there is consensus that it is unethical not to conduct research with children; consent should be obtained from both the child and the parent or guardian; where the child does not have sufficient understanding of what is involved and the implications of such involvement, the assent of the child should be sought; children involved in research should be made aware that, where information concerning risks to themselves or others emerges, confidentiality cannot be guaranteed; and finally researchers must consider the potential impact of research participation on the child, building methods of providing support to children into the research proposal.